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UVA Department of Medicine: FY 2015 Annual Report

Clinical

Division of Gastroenterology & Hepatology
CLINICAL ACTIVITIES

Sauer&Shama

Gastroenterology faculty members Bryan Sauer, MD, MS, and Vanessa Shami, MD.

During FY 2015, the division saw an 18 percent increase in patient volume and a substantial expansion of all its clinical activities, due largely to the hiring of new faculty members. These were:

Three more faculty were recruited during spring 2015, and slated to join the division at the start of FY 2016:

With these additions and the launch of new clinical service locations in the upcoming year, the division expects its clinical programs to enjoy continued growth in FY 2016.

Clinic Locations for Gastroenterology and Hepatology

Currently, the division sees patients at:

New locations opened in FY 2015 or slated to open in FY 2016:

UVASurgicalMonticello

Monticello Community Surgery Center, where the division now offers endoscopy services.

New Endoscopy Location

The division has expanded its practice locations for endoscopy services — at University Hospital and at the Outpatient Surgery Center (Battle Building) — to include Monticello Community Surgery Center, on U.S. Route 29 North in Charlottesville (2331 Seminole Ln., Suite 201). Cynthia Yoshida, MD, performs procedures there two-and-a-half days a week. The rest of the division faculty provides services for the other two-and-a-half days a week, on a rotating basis. This additional location provides the division’s patients with better access to its endoscopy services.

Clinically Distinctive Programs (2014–2015)

Inflammatory Bowel Disease (IBD)

The IBD program at UVA provides a multidisciplinary approach to care of patients with complex inflammatory bowel disease. Novel surgical and medical approaches, including the introduction of a number of new biologics for treating IBD, have revolutionized therapy and are producing significant improvements in outcomes for these patients. The IBD program at UVA is also a major site for clinical research and industry-sponsored clinical trials in Crohn’s disease and ulcerative colitis. The availability of cutting-edge, multidisciplinary therapy and clinical trials at UVA are a major draw for patients with complex IBD. The program is expanding with the addition of Mary Overby, BSN, MSN, FNP.

Advanced Therapeutic Endoscopy

The interventional GI faculty at UVA performs the most technically advanced services in Virginia, including:

  • Endoscopic retrograde cholangiopancreatography
  • Endoscopic ultrasound
  • Radiofrequency ablation for Barrett’s esophagus
  • Complex endoscopic mucosal resection
  • Endoscopic submucosal dissection
  • Confocal endomicroscopy
  • Small bowel enteroscopy
  • Enteral stenting
  • Peroral endoscopic myotomy

Underwater Endoscopic Mucosal Resection (UEMR)

The division began performing UEMR in 2012, and was one of the first to publish on this novel procedure. In FY 2015, it continued to perform many of these procedures, removing lesions from throughout the GI tract. UEMR has been particularly helpful at removing large precancerous duodenal neoplasms and large precancerous colorectal neoplasms. Outside of San Francisco, where the technique was developed, UVA is among the most experienced centers nationwide performing the procedure.

Endoscopic Submucosal Dissection (ESD)

ESD is a procedure for removing dysplastic lesions and early cancers from the luminal GI tract. Currently, UVA is the only medical center in Virginia that offers and performs this procedure. In 2015, the division performed the first colonic ESD, a successful procedure that prevented the patient from requiring a hemicolectomy.

Peroral Endoscopic Myotomy (POEM)

In FY 2015, the division began offering POEM procedures; these treat patients with dysphagia due to achalasia. UVA is the only center in Virginia that offers POEMs performed by a gastroenterologist, and the division has received referrals from providers in Virginia and West Virginia. A total of seven were performed in AY 2015, each achieving clinical success, with no complications.

Hepatitis C Treatment

The division’s hepatology faculty members have participated in many clinical trials that are now revolutionizing treatment for hepatitis C, and they are able to offer the latest approaches to medical therapy for the disease. They work collaboratively with physicians in the Division of Infectious Diseases to provide comprehensive care for these patients.

Treatment Of Advanced End-Stage Liver Diseases & Liver Transplantation

GI’s Advanced End-Stage Liver Diseases and Liver Transplantation program offers multidisciplinary therapeutic approaches to the care of patients with cirrhosis, including a number of distinctive advanced technologies, including:

The division also provides expert care of patients being evaluated for or awaiting liver transplantation.

Liver Transplant Program

Under the leadership of Patrick Northup, MD, the liver transplant program continued to thrive in FY 2015. Of note, the living donor transplant program (LDLT), directed by Curtis Argo, MD, has grown over the last 18 months; Dr. Argo projects that at least 12 of those on UVA’s waiting list will undergo transplants via LDLT in 2015 — approximately 15–20 percent of the division’s projected number of total liver transplants for the year. The division also initiated a LDLT Donor Champion program, which helps recipients and their families identify a primary advocate who then takes the lead role in identifying potential living donor candidates. With the start of the Donor Champion program, the number of intakes for donor candidate has tripled. The LDLT program also had another first in 2015 in performing the division’s first LDLT from a nondirected, altruistic donor.

Fecal Microbiota Transplant Program

Started in FY 2013, the fecal microbiota transplant program has continued to grow, and the Buchanan FMT Laboratory, which processes, freezes and banks specimens, became fully operational in fall 2013. The FMT program has access to prescreened and processed universal donor frozen stool material through the nonprofit OpenBiome organization.

A UVA clinic for complicated C. difficile infection (CDI) was established at UVA in conjunction with the FMT program in November 2013. To date:

  • More than 180 patients with recurrent CDI have been evaluated for FMT treatment.
  • 89 outpatients with recurrent CDI have been treated with FMT.
  • 95 percent of those receiving FMT treatments were negative for CDI at week two.
  • 93 percent were CDI-negative at six months.
  • Two of the outpatients treated with FMT died before the six-month follow-up; neither of these deaths were related to CDI.

Gastric Varices

A sometimes-fatal complication of cirrhosis or pancreatitis, gastric varices present unique challenges in clinical management. As a result of the division’s development of endoscopic cyanoacrylate therapy in 1998, initially as an investigator-initiated clinical research protocol, it routinely receives referrals from other academic centers, including Northwestern University, University of Cincinnati, Georgetown, University of North Carolina, Penn State University and University of Maryland. In its management and treatment of gastric varices, the division’s advanced endoscopy team collaborates with the Vascular and Interventional Radiology group in the Department of Radiology. This allows an innovative and personalized approach to the triaging of patients, depending on the underlying vascular anatomy of each patient.

Division of Gastroenterology & Hepatology: Clinical Statistics – FY 2015

 

Division Productivity, FY 2015
Volume Vol. Change (%) wRVU wRVU Change (%)
Inpatient Attending 7,064 +15 14,114 +16
Inpatient Consults 3,287 +38 7,859 +32
Clinic Visits 12,075 +18 22,978 +12
Transplant Clinic 1,252 +10 2,189 +6
Endoscopy 13,053 +12 52,188 +10
Motility 495 +45 745 +64
Total 37,226 +18 100,204 +14
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